Abstract
ObjectiveWe sought to determine differences with cardiovascular magnetic resonance (CMR) in the morphology and composition of the carotid arteries between individuals with angiographically-defined obstructive coronary artery disease (CAD, ≥ 50% stenosis, cases) and those with angiographically normal coronaries (no lumen irregularities, controls).Methods and results191 participants (50.3% female; 50.8% CAD cases) were imaged with a multi-sequence, carotid CMR protocol at 1.5T. For each segment of the carotid, lumen area, wall area, total vessel area (lumen area + wall area), mean wall thickness and the presence or absence of calcification and lipid-rich necrotic core were recorded bilaterally. In male CAD cases compared to male controls, the distal bulb had a significantly smaller lumen area (60.0 ± 3.1 vs. 79.7 ± 3.2 mm2, p < 0.001) and total vessel area (99.6 ± 4.0 vs. 119.8 ± 4.1 mm2; p < 0.001), and larger mean wall thickness (1.25 ± 0.03 vs. 1.11 ± 0.03 mm; p = 0.002). Similarly, the internal carotid had a smaller lumen area (37.5 ± 1.8 vs. 44.6 ± 1.8 mm2; p = 0.006) and smaller total vessel area (64.0 ± 2.3 vs. 70.9 ± 2.4 mm2; p = 0.04). These metrics were not significantly different between female groups in the distal bulb and internal carotid or for either gender in the common carotid. Male CAD cases had an increased prevalence of lipid-rich necrotic core (49.0% vs. 19.6%; p = 0.003), while calcification was more prevalent in both male (46.9% vs. 17.4%; p = 0.002) and female (33.3% vs. 14.6%; p = 0.031) CAD cases compared to controls.ConclusionMales with obstructive CAD compared to male controls had carotid bulbs and internal carotid arteries with smaller total vessel and lumen areas, and an increased prevalence of lipid-rich necrotic core. Carotid calcification was related to CAD status in both males and females. Carotid CMR identifies distinct morphological and compositional differences in the carotid arteries between individuals with and without angiographically-defined obstructive CAD.
Highlights
Cardiovascular Magnetic resonance (CMR) is a non-invasive imaging modality that has enabled the assessment of both the morphological [1] and compositional characteristics of the carotid arterial wall
In the study described we evaluated baseline data from this cohort and tested the hypothesis that individuals with and without obstructive coronary artery disease (CAD) differ in their carotid arterial wall morphology and composition as identified by high spatial resolution carotid CMR
Males with obstructive CAD had significantly smaller carotid arteries with thicker walls and an increased prevalence of lipid-rich necrotic core. These findings were limited to the carotid bulb and internal carotid artery (ICA). In contrast to these gender-specific differences, calcification was related to CAD status in both males and females
Summary
Cardiovascular Magnetic resonance (CMR) is a non-invasive imaging modality that has enabled the assessment of both the morphological [1] and compositional characteristics of the carotid arterial wall. The high reproducibility [5,6,7] of carotid CMR has made possible the effective quantitative assessment of plaque evolution [8] and the identification of compositional features associated with accelerated progression [9]. Studies with carotid CMR, have been limited to the evaluation of subjects with established carotid disease [10,11]. These and other carotid studies [12] have proven invaluable in the assessment of local plaque phenomena, the relationship between CMR identified carotid disease and atherosclerotic disease in other arterial beds has not previously been reported. Multiple investigations have successfully employed B-mode ultrasound to identify differences in carotid intima-media thickness (IMT) between individuals with and without coronary artery disease (CAD) [14,15]
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